Dorsal column stimulator treatment in philadelphia pa
![dorsal column stimulator treatment in philadelphia pa dorsal column stimulator treatment in philadelphia pa](https://i.ytimg.com/vi/htO_BuGkuSE/maxresdefault.jpg)
Injuries below T6 do not typically result in autonomic dysreflexia due to the intact splanchnic innervation. Dysreflexia is often initiated by noxious stimuli below the level of the spinal cord injury, including cutaneous or visceral etiologies, but is most often triggered by a urologic source such as urinary tract infection or bladder distention. Parasympathetic compensation, including bradycardia and vasodilation, occurs only above the level of the injury, resulting in sweating, chills, headache, and flushing. Autonomic dysreflexia results in sympathetic over activity causing hypertension that increases the risk of stroke, pain, and hemodynamic instability.
![dorsal column stimulator treatment in philadelphia pa dorsal column stimulator treatment in philadelphia pa](https://patentimages.storage.googleapis.com/US8676329B2/US08676329-20140318-D00001.png)
SCI proximal to T6 level may result in autonomic dysreflexia, affecting autonomic responses to demands on vascular tone and heart rate, with greater severity of dysregulation associated with higher levels of injury. CAD risk factors, including hyperlipidemia, diabetes, and obesity, that exist within the SCI population have primarily been attributed to the sedentary nature of SCI patients. The prevalence of symptomatic cardiovascular disease ranges from 30% to 50% compared with 5–10% in matched able-bodied populations. SCI patients also have increased risk of ischemic heart disease because of the increased prevalence of coronary artery disease (CAD) and hypertension after SCI. Poor respiratory muscle recruitment in combination with inhibited reflexes results in impaired cough, bronchospasm, and increased secretions, predisposing SCI patients to pneumonia, atelectasis, and exacerbation of respiratory failure. In patients with prolonged ventilation, tracheostomy may be required. SCI in the cervical or high thoracic regions can disrupt respiratory muscle function, ranging from exercise intolerance to complete respiratory failure requiring mechanical ventilation assistance. The annual incidence of pressure ulcers in SCI patients ranges from 20% to 31%, with the resulting increased healthcare utilization approximately quadrupling annual costs compared with SCI patient without ulcers. These changes delay the natural wound healing capabilities below the level of the injury, resulting in ulceration. Ulceration occurs due to persistent pressure over bony prominences as a result of immobility, poor nutrition, and changes in skin physiology including deficient vascular reactions to catecholamine signaling and decreased fibroblast activity. One of the most common adverse events following an SCI is pressure ulcers due to insensate regions. The resulting osteoporosis is typically isolated to the long bones below the level of injury, increasing the risk of fragility fractures. Cessation of weight bearing in these patients leads to increased bone resorption and suppressed bone formation. ĭue to mobility limitations, paraplegia or tetraplegia patients do not load their spine or limbs, disturbing bone homeostasis as a result of mechanical unloading. However, these must be weighed against the negative effects that include contractures, gait disturbances, decreased mobility, and pain. Spasticity may potentially have beneficial effects by promoting venous return, decreasing the incidence of orthostatic hypertension and deep venous thrombosis, increasing stability, and facilitating activities such as transfers. Spasticity is a velocity-dependent increase in muscle tone due to a hyperexcitable stretch reflex. Any complete level thoracic SCI results in paraplegia, however, SCI distal to L2 level may spare varying lower extremity function.ĭamage to descending spinal cord tracks results in hyperexcitability and spasticity. These patients require less assistance and fewer adaptive aids for activities of daily living. SCI below C6 results in relatively greater independence, with patients able to achieve transfers either with the assistance of a transfer board (C6) or independently (C7/C8). The C6 nerve root controls wrist extension and biceps flexion, the C7 nerve root controls elbow extension and wrist flexion, and the C8 nerve roots controls finger flexion. Accordingly, C5 complete SCI (ASIA A) results in complete dependence for transfers and assistance for activities of daily living. The C5 nerve root primarily innervates the deltoid muscle to perform shoulder abduction, but is also responsible elbow flexion.
![dorsal column stimulator treatment in philadelphia pa dorsal column stimulator treatment in philadelphia pa](https://i.pinimg.com/originals/dc/e9/f8/dce9f8e44716cbefb30a3099711ab415.jpg)
While C1–C4 SCI typically results in tetraplegia, lower cervical (C5–C8) SCI can spare varying degrees of upper extremity function.
![dorsal column stimulator treatment in philadelphia pa dorsal column stimulator treatment in philadelphia pa](https://i.ytimg.com/vi/wzpk0U4KPn4/maxresdefault.jpg)
The SCI level determines which systems are affected and has a significant impact on the potential rehabilitation and final functional status of the patient. Neurologic injury of the spinal cord affects nearly every physiologic system, and patients can present with a multitude of symptoms that drastically influence their function and quality of life.